title: High levels of mannose-binding lectin are associated with poor outcomes after lung transplantation.
abstract: BACKGROUND
  Mannose-binding lectin (MBL) is a key molecule of the innate immune system and, in addition to the classical and alternative pathways, a principle driver of complement activation. Genetic mutations of MBL are common, result in low serum levels of MBL, and are associated with increased infection risk in solid-organ transplant recipients.
  
  
  METHODS
  We performed a retrospective study of MBL2 genotype and plasma and bronchoalveolar lavage (BAL) MBL levels in 37 lung transplant recipients (LTR). Plasma MBL levels were measured pretransplant and both plasma and BAL MBL levels were measured at 3, 6, and 12 months after lung transplantation. MBL2 genotyping was performed on recipient and donor peripheral blood mononuclear cells. Clinical variables analyzed included primary graft dysfunction, intensive care unit stay, acute allograft rejection, infection, bronchiolitis obliterans syndrome (BOS), and mortality.
  
  
  RESULTS
  Plasma MBL levels posttransplant were predicted by recipient, and not donor MBL2 genotype. Compared with pretransplant levels, plasma MBL was significantly increased at 3, 6, and 12 months posttransplant (P<0.05). LTR who developed BOS or died during the study period had higher plasma MBL levels at 6 and 12 months posttransplant (P ≤ 0.05) compared with LTR with stable graft function. MBL was not routinely detected in the lung allograft; however if present in the BAL at 3 and 6 months posttransplant, it was associated with the later development of BOS (P<0.05).
  
  
  CONCLUSIONS
  Plasma MBL levels increase after lung transplantation and persistently increased MBL levels are associated with poor long-term outcomes.
authors.affiliation: Department of Respiratory Medicine St Vincent's Hospital, Victoria, Australia.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Carroll
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Dean
authors.forename: Susan L
authors.initials: SL
authors.lastname: Heatley
authors.forename: Aislin C
authors.initials: AC
authors.lastname: Meehan
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Mifsud
authors.forename: Tom C
authors.initials: TC
authors.lastname: Kotsimbos
authors.forename: Greg I
authors.initials: GI
authors.lastname: Snell
authors.forename: Glen P
authors.initials: GP
authors.lastname: Westall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000209:etiology; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D015331:Cohort Studies; D005260:Female; D005838:Genotype; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D016040:Lung Transplantation / Q000009:adverse effects* / Q000502:physiology*; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood* / Q000235:genetics / Q000378:metabolism; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C445619:MBL2 protein, human; D037601:Mannose-Binding Lectin